Comparison of Lafutidine and Rabeprazole in 7‐day Second‐line Amoxicillin‐ and Metronidazole‐Containing Triple Therapy for Helicobacter pylori: A Pilot Study

Kudo, Takahiko; Fujinami, Haruka; Ando, Takayuki; Nishikawa, Jun; Ogawa, Kohei; Hosokawa, Ayumu; Orihara, Tadahiro; Murakami, Jun; Takahara, Taro; Sugiyama, Toshiro

doi:10.1111/j.1523-5378.2012.00943.x

Cited by 14 publications

(8 citation statements)

References 21 publications

(26 reference statements)

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“…Studies reporting duplicate data were excluded. After careful evaluation, 36 studies (including 3466 patients) were found to perform antibiotic susceptibility determinations and were included in the systematic review. Of these 36 articles, 24 reported cure rates according to antibiotic resistances/susceptibilities, including 37 arms of treatment.…”

Section: Resultsmentioning

confidence: 99%

“…In 16 of 36 articles, endoscopy was an inclusion criterion and was performed in all patients; therefore, the rate of acceptance of the procedure could not be evaluated. Nine additional articles performed endoscopy in all patients but did not state whether the procedure was an inclusion criteria or whether patients who rejected endoscopy had been excluded . In another 10 articles, endoscopy was not performed in all patients but the reasons for not doing so were not stated, nor whether endoscopy was offered to all patients .…”

Section: Resultsmentioning

confidence: 99%

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Systematic review: Would susceptibility‐guided treatment achieve acceptable cure rates for second‐line Helicobacter pylori therapy as currently practiced?

et al. 2019

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Background Susceptibility‐guided treatment has been proposed as a way to improve Helicobacter pylori eradication rates. Evidence on its efficacy for rescue therapy is very scarce. The aim of this study was to indirectly assess the applicability and effectiveness of susceptibility‐guided treatment by evaluating (a) the rate of acceptance of endoscopy, (b) its success in detecting resistances, and (c) infection cure rates in patients harboring strains found to be susceptible to the antibiotics administered in clinical trials in which the efficacy of second‐line treatments was reported. Methods A systematic review of studies evaluating second‐line H pylori treatment was carried out in multiple databases. Studies reporting antibiotic susceptibility evaluation and/or cure rates in patients harboring sensitive and resistant strains were selected. Data were extracted in duplicate. Results The systematic review identified 36 eligible studies. Acceptance was evaluated in only one study of 60 patients, of whom only 38 agreed to endoscopy. Among the 2890 patients who received endoscopy and culture, resistances were finally determined in 86.5%. Cure rate was 72.5% in the 113 patients harboring a clarithromycin‐susceptible strain after previous clarithromycin treatment, 93.5% in the 765 patients harboring a metronidazole‐susceptible strain, and 83.8% in the 192 patients harboring a levofloxacin‐susceptible strain. No studies with repeated administration of levofloxacin or metronidazole were found. Conclusion Even if the culture shows a clarithromycin‐sensitive strain, repeating clarithromycin after a first failure should be discouraged. Susceptibility‐guided treatment alone did not achieve adequate cure rates for rescue therapies. Additional measures are needed to design rescue treatments that consistently achieve excellent cure rates.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Systematic review: Would susceptibility‐guided treatment achieve acceptable cure rates for second‐line Helicobacter pylori therapy as currently practiced?

et al. 2019

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“…It activates capsaicin-sensitive afferent neurons and stimulates the release of CGRP which, in turn, inhibits acid secretion and stimulates mucosal blood flow. [910] In addition to gastroesophageal reflux disease, clinical trials have reported lafutidine to be effective in Helicobacter pylori eradication[19] and prevention of non-steroidal anti-inflammatory drug (NSAID) induced ulceration. [20] Our experience is in conformity with an earlier study which suggests that both lafutidine and rabeprazole provide symptom relief and are adequate empiric therapy in patients with heartburn-dominant uninvestigated dyspepsia.…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of effectiveness of lafutidine versus pantoprazole in uninvestigated dyspepsia

et al. 2014

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Objectives:Lafutidine is a new H2-blocker in India claimed to be more potent and effective than existing H2-blockers. Proton pump inhibitors (PPIs), by virtue of their mechanism of action, have greater efficacy than H2-blockers in gastric acid suppression. However, clinical trials comparing H2-blockers directly with PPIs are limited. We carried out a head-to-head comparison of the effectiveness of lafutidine versus the PPI pantoprazole in uninvestigated dyspepsia [CTRI/2013/12/004261].Materials and Methods:A prospective, open label, randomized, controlled trial was conducted in a tertiary care hospital. Ambulatory adult patients with dyspepsia, not yet subjected to endoscopy, were recruited if they had at least moderately severe symptoms, defined as a score of ≥ 4 on a 7-point Global Overall Symptom (GOS) Scale. Those with alarm features or significant comorbidity were excluded. Subjects received either once daily lafutidine 10 mg or pantoprazole 40 mg, orally, for 8 weeks. Reflux, dysmotility and pain scores were assessed by Modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (mFSSGERD), and quality of life (QoL) by SF-8 scale. The latter had physical and mental components summarized by physical component summary score (PCS) and a mental component summary score (MCS).Results:Of 122 patients enrolled, data of 57 on lafutidine and 60 on pantoprazole were analyzed. At 4 weeks, proportion of subjects responding (GOS score ≤ 2) in the two arms (lafutidine 45.61% vs. pantoprazole 48.33%, P = 0.854) or showing symptom resolution (GOS score ≤ 1) (lafutidine 12.28% vs. pantoprazole 5.00%; P = 0.197) were comparable. Similarly at 8 weeks, both responder (lafutidine 52.63% vs. pantoprazole 56.67%; P = 0.712) and symptom resolution proportions (lafutidine 33.33% vs. pantoprazole 30%; P = 0.843) were comparable. Total score on mFSSGERD scale, as well as all its three component scores, and PCS and MCS scores on QoL SF-8 scale showed improvement but no statistically significant difference between the two arms. Tolerability of both drugs was excellent.Conclusions:Lafutidine is well-tolerated and there is no clinically worthwhile difference between the two drugs in the empirical treatment of uninvestigated dyspepsia.

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“…The OAC group demonstrated a higher additive effect of PPIs than the OMC group (70 vs. 19% increase). In addition, we have recently published that the eradication rate of PPI-based triple therapy containing metronidazole is equal to a strong histamine receptor inhibitor-based triple therapy in second-line treatment against H. pylori infection [22]. The second indirect Elevation of antibacterial activity of antibiotics in the stomach Antibacterial activity Concentration of gastric juice Antiurease activity Stabilization of sIgA in the gastric lumen Anti-ATPase activity effect is the concentration of the combined antibiotics in the stomach.…”

Section: How Do Proton Pump Inhibitors Show Antibacterial Effects Agamentioning

confidence: 97%

Proton Pump Inhibitors: Key Ingredients in Helicobacter pylori Eradication Treatment

Sugiyama¹

2013

Frontiers of Gastrointestinal Research

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The combination of a proton pump inhibitor (PPI) with two of the following three antibiotics, amoxicillin, clarithromycin, and metronidazole, has been reported to achieve a high eradication rate. These regimens are accepted as standard regimens worldwide. The rationale of PPI-based triple therapy has been established by many clinical trials and a large body of experimental evidence. PPIs have a pivotal effect in the eradication of Helicobacter pylori infection, both indirect effects and direct effects. PPIs have a weak antibacterial effect against H. pylori in vitro, antiurease activity, and anti-ATPase activity. In fact, clinical trials have demonstrated that PPIs alone have a weak eradication effect. Indirect synergistic effects of PPIs could be raising the eradication rate in PPI-based triple regimens. The most potent effects are to stabilize and to raise antibacterial effects of the combined antibiotics, especially clarithromycin and amoxicillin in the hostile gastric environment. These are key antibiotics in an eradication treatment of H. pylori infection. In addition, PPIs have a potent activity to concentrate the antibiotics via suppressing gastric juice. Thus, the indirect effect might be an important role to raise the eradication rate by PPI-based triple therapy in clinical aspects. PPIs have different metabolic pathways, which depend on the CYP enzymes in the liver. Therefore, polymorphism of CYP enzymes might influence eradication rates in PPI-based regimens. The pharmacological characteristics of each PPI including the time exhibiting acid suppressive effect, metabolic pathway, and bioavailability should be considered to achieve a higher eradication rate in PPI-based triple treatment.Helicobacter pylori is recognized as the main etiological factor in the pathogenesis of histologic gastritis, gastric ulceration, duodenal ulceration, gastric MALT lymphoma, and gastric cancer. Treatment to eradicate H. pylori infection has been proven to prevent completely the relapse of gastric or duodenal ulceration and has changed the natural history of ulcer diseases [1][2][3]. Recent strong evidence has demonstrated that the eradication of H. pylori infection might prevent the development of gastric cancer [4]. In addition, the eradication has been proven to improve gastric MALT lymphoma

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Comparison of Lafutidine and Rabeprazole in 7‐day Second‐line Amoxicillin‐ and Metronidazole‐Containing Triple Therapy for Helicobacter pylori: A Pilot Study

Cited by 14 publications

References 21 publications

Systematic review: Would susceptibility‐guided treatment achieve acceptable cure rates for second‐line Helicobacter pylori therapy as currently practiced?

Systematic review: Would susceptibility‐guided treatment achieve acceptable cure rates for second‐line Helicobacter pylori therapy as currently practiced?

Randomized controlled trial of effectiveness of lafutidine versus pantoprazole in uninvestigated dyspepsia

Proton Pump Inhibitors: Key Ingredients in <b><i>Helicobacter pylori </i></b>Eradication Treatment

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